Discharge rules tie hands of local doctors battling overdose epidemic

Thursday

Apr 3, 2014 at 6:00 AM

Doctors at Good Samaritan Medical Center in Brockton try new methods to key addicts recovering from opiate overdoses at the hospital longer

Staff Reporter

BROCKTON – Doctors at Good Samaritan Medical Center talk to victims of drug overdoses about the dangers of hitting the streets too soon after emergency treatment. They offer hot meals, television and telephone access.They do this because an extra hour or two at the hospital means limiting the chances a patient suffers from repeated overdoses, which doctors say increases the risk of dying from an overdose.

As the medical community in Massachusetts – along with the courts, law enforcement and public officials – takes on the spike in opiate overdose deaths that prompted Gov. Deval Patrick to declare a public health emergency, physicians on the front lines face significant hurdles to keeping overdose patients safe.

“The emergency department is the place where the drama plays out,” said Dr. Rick Herman, chief of emergency medicine at Good Samaritan. “If they’re near-death we can bring them back to life. But the real issues extend way beyond the ER visit.”

As part of Patrick’s announcement last week, the governor put in motion a plan to make the overdose-reversal drug Narcan more easily available to all public safety personnel. The drug is essentially harmless and has been hailed as a lifesaver among addiction treatment advocates, some of whom say it should be available over-the-counter.

But confounding ER doctors is what happens after Narcan is administered, and after a patient no longer appears to be an immediate threat to their own safety or others.

“There is very little that we can do to stop them from leaving,” said Dr. Steven Epstein, a nationally-recognized expert on emergency room medicine and a physician at Beth Israel Deaconess Medical Center.

“You want to try to stop that if you can,” he said. “But to some degree it has to come from the patient.”

Unless an adult’s intoxicated state clearly puts them in danger, or they admit to suicidal or violent tendencies, they cannot be held by a hospital against their will.

Under state law, a family member can seek an order from a judge mandating substance abuse treatment, but only after presenting evidence at a hearing. And once an order is issued, a police officer must be present at a hospital to bring the person before a judge, Dr. Epstein said.

By contrast, when juveniles are treated for a drug or alcohol overdose, state laws mandates that the medical provider notify their parent or guardian, provide a substance abuse pamphlet and provide access to a social worker.

Cathy Gilmore, the mother of a 27-year-old man who was struck and killed by a commuter train in Norwood just minutes after being released from the hospital for an opiate overdose, is pushing legislation that would require a 48-hour stay for overdose patients.

Norwood Hospital officials, in an addendum to Anthony Gilmore’s medical record, said Gilmore did not say he had the intention of hurting himself or others and that he “was alert and oriented, coordinated and ambulatory upon discharge. His overdose was really an excessive dose, and at no time was he in danger because of it.”

Herman said that a case like Gilmore’s is difficult for physicians because holding a patient depends on their immediate medical condition. He has been working with the Brockton police and the Plymouth County district attorney’s office to make discharge safer for adults.

A plan still in its preliminary stages would send a specially trained police officer to Good Samaritan to try and convince an overdose patient to remain longer in the hospital. But if they want to leave, the department would have no legal standing to stop them, Chief Robert Hayden said.

“I’d like to see them stay in the hospital until the effects of the heroin have gone through their system,” Hayden said. “The feeling I had was if a uniformed police tells a guy, ‘Stay here, you’re not going back out on the street,’ it will carry a lot more weight than a doctor with a stethoscope.”

The legal underpinnings of the partnership are still being worked out, Dr. Herman said. A spokesman for the Plymouth District Attorney Timothy Cruz said he did not have information immediately available on the program Wednesday.

“There’s no provider who wants to let someone out and overdose again,” Herman said. “You have to weigh personal privacy with public safety.”

In January, Good Samaritan treated 33 patients for heroin overdoses, triple the average per month in 2013.

Along with the discharge initiative, Herman said his hospital put in place a policy in 2012 to limit opioid prescriptions. He would like to see similar efforts undertaken throughout Plymouth County and around the state.

“We want to make an impact,” Herman said. “In the last 34 years, this is the worst I’ve seen it.”